The State Of Healthcare
August 28, 2006— -- Recovery remains way off for a New Orleans health care system washed away by floodwaters a year ago. Many doctors and nurses who helped evacuate patients are still there. Some still live in trailers. Many others have left. So many that there are severe shortages of health care workers.
For patients, that can mean waiting days -- or driving out of town -- to get treatment. And it could get worse before it gets better as hospitals consider cutting services this year. With living still hard in the city, state health officials fear even more health care workers will leave. Replacing them won't be easy, as life in New Orleans remains a tough sell for medical recruiters.
Even before Katrina, New Orleans health care needed an overhaul. The city was one of the unhealthiest in the United States. By destroying this old system, state and federal officials say, the floods have provided an unprecedented opportunity to build, from the ground up, a new system that can be a model for the rest of the nation. But it will be years before that ambitious goal can translate into better care for patients. In the meantime, the city's health care system remains in critical condition.
HOSPITALS
Before Katrina, there were six hospitals in Orleans Parish. Now there are just three. The state estimates a need of 240 more hospital beds. There is no longer a Level 1 trauma center in the city -- a problem compounded by the persistent crime problem.
Pre-Katrina, New Orleans had about 2,300 hospital beds available. As of 8/17/06, the number was below 500. In other words, 2 out of every 3 hospital beds are out of circulation
Generations of uninsured and underinsured relied on the state-run Charity Hospital for care. Charity (where about 200 patients and doctors were trapped in deplorable conditions during the storm) is now boarded up for good.
The state and federal government have agreed to build a $1.2 billion complex to pick up that slack, but it's not scheduled to open until 2011. In the meantime, the uninsured are overwhelming the city's for-profit hospitals.
Within the next couple months, Dr. Mark Peters, board Chairman of the Metropolitan Hospital Council of New Orleans, says "all hospitals" will consider cutting back services (even more than have already). According to Jack Finn, President of the Metropolitan Hospital Council of New Orleans, "Since the storm, everybody's losing money – anywhere between maybe a million dollars a month to about $9 million a month." (AP 7/24/06)
SHORTAGE OF CAREGIVERS
State officials report severe shortages of specialists, psychiatrists, dentists, registered nurses, nurses' aides, ambulance drivers, emergency medical technicians and many other hospital support jobs. The city of New Orleans has also cut about three-quarters of its health department staff.
Community health care officials say up to 70 percent of the area's doctors and nurses haven't returned to the damaged parts of Louisiana. Only a quarter (1,200 out of 4500) of New Orleans's doctors have returned, with specialists being particularly scarce
Susan D'Antoni, director of the Great New Orleans Medical Foundation, says between 30 and 40 percent of the area's doctors have permanently settled elsewhere.
A survey done by the Louisiana Health Works Commission reported almost 1,000 nursing and certified nursing vacancies in the region.
The Louisiana Board of Nursing reports a 27% decrease in the number of nurses renewing their license as of July 2006 in Region 1 (the 4 parishes most severely affected by Katrina).
Based on the number of physicians and the percentage of people who've returned to New Orleans, the metropolitan area has approximately a 16-24% primary care physician shortage. Hurricane Recovery Plans Report, LDHH
Katrina affected about 6,000 physician practices on the Gulf Coast.
Blue Cross Blue Shield of Louisiana found that only half of their total number of pre-Katrina doctors are filing clams post-Katrina in the region….almost 100% of this reduction took place in Orleans Parish. Region 1 Health Care Profile
MENTAL HEALTH NEEDS
Doctors, state officials and police say mental health is the biggest medical crisis in the city. All of the city's psychiatric hospitals have closed. There's a severe shortage of mental health workers and psychiatric hospital beds combined with a rise in chronically mentally ill patients. Many who were healthy before the floods suffered severe mental trauma. And those who were sick before are deteriorating for lack of psychiatric care.
Orleans Parish Deputy Psychiatric Coroner, Dr. Jeffery Rouse, says estimates reveal that the area has lost 89% of its psychiatrists.
Pre-Katrina, there were 480 psychiatric beds in metropolitan New Orleans (Jefferson Parish, St. Bernard Parish, and Orleans Parish)
Only one-sixth of those beds are now available
On June 14, 2006, only 2 psychiatric beds were available within 25 miles of New Orleans
A Kaiser Family Foundation Report found that almost all low-income survivors surveyed in report were suffering from emotional trauma, but few said they'd received formal counseling. Health Experiences of Low-Income Katrina Survivors
A study from the Substance Abuse and Mental Health Services Administration calculated that up to half a million people from the Katrina-affected region would need mental-health services. (The annual cost of treating one mentally ill person in the state is almost $3000.)
A separate study showed that at least 100,000 children who experienced Katrina were likely to have Post-Traumatic Stress Disorder.
Almost half the children in one poll reported experiencing anxiety, depression and sleep problems after Katrina, according to a Journal of AMA Report
Four months after the storm, suicides in Orleans Parish rose almost threefold.
ACCESS TO HEALTHCARE
Pre-Katrina, Mississippi and Louisiana placed near the bottom of national health care rankings. Post-Katrina, the health care situation deteriorated even more.
Approximately 40% of the area's residents have no medical insurance, doubling the pre-Katrina rate
The uninsured survivor population still has trouble meeting basic (esp. health) needs. Unaffordable costs, limited healthcare, and long waits aggravate the problem.
EFFORTS TO REBUILD A BROKE AND CRIPPLED SYSTEM
The U.S. Department of Health and Human Services has given Louisiana $100 million for health and medical programs, along with $383 million to compensate hospitals and doctors for treating uninsured patients. However, this is a small amount covered to the $10-30 billion the state has received for levee repair, disaster aid, and home reconstruction
The state Department of Health and Hospitals announced that Louisiana Spirit, a federally funded crisis counseling program in the state health department, will continue its mental health services to hurricane victims with the help of a $35 million federal grant from FEMA - one of the biggest federal grants ever awarded for crisis counseling.
The Louisiana Health Care Redesign Collaborative will work toward an Oct. 20 deadline "to submit a redesign proposal to the federal government that will restructure health care delivery in the Greater New Orleans region." State and federal officials hope to build a system that's less anchored to hospital centers involving more neighborhood clinics and preventive care.